Influences of different lower cervical bone graft heights on the size of the intervertebral foramen: multiple planar dynamic measurements with laser scanning.

The aim of this study is to evaluate the influences of different bone graft heights on the size of the intervertebral foramen, which will help determine the optimal graft height in clinical practice. Six fresh adult cadavers were used, with the C5-C6 vertebral column segment defined as the functional spinal unit (FSU). After discectomy, the C5/6 intervertebral height was set as the baseline height (normal disc height). We initially used spiral computed tomography (CT) to scan and measure the middle area of the intervertebral foramen when at the baseline height. Data regarding the spatial relationship of C5-C6 were subsequently collected with a laser scanner. Grafting with four different sized grafts, namely, grafts of 100, 130, 160, and 190% of the baseline height, was implanted. Moreover, we scanned to display the FSU in the four different states using Geomagic8.0 studio software. Multiple planar dynamic measurements (MPDM) were adopted to measure the intervertebral foramen volume, middle area, and areas of internal and external opening. MPDM with a laser scanner precisely measured the middle area of the intervertebral foramen as spiral CT, and it is easy to simulate the different grafts implanted. With the increase of the bone graft height, the size of the intervertebral foramen began to decrease after it increased to a certain point, when grafts of 160% of the baseline height implanted. MPDM of the intervertebral foramens with laser scanning three-dimensional (3D) reconstitution are relatively objective and accurate. The recommended optimal graft height of cervical spondylosis is 160% of the mean height of adjacent normal intervertebral spaces.

Anterior Cervical Corpectomy and Fusion Using a Synthetic Hydroxyapatite Graft for Ossification of the Posterior Longitudinal Ligament.

The significant complication rate associated with harvesting autologous iliac bone or fibula has encouraged development of alternative graft substitutes. In this study, the authors investigated the efficacy and safety of synthetic porous hydroxyapatite (HA) combined with local vertebral bone graft for use in anterior cervical corpectomy and fusion (ACCF) for the treatment of patients with ossification of the posterior longitudinal ligament (OPLL). Since 2006, twenty-five OPLL patients underwent ACCF using HA blocks (HA group). Hydroxyapatite blocks with 40% porosity were used for the 1-level ACCFs, and HA blocks with 15% porosity were used for the 2-level ACCFs. Clinical and radiological evaluation was performed with a minimum of 2-year follow-up. Outcomes were compared with those of 25 OPLL patients who underwent ACCFs using auto-fibula grafts at the authors' institution before 2006 (FBG group). Patients' demographic data were similar in the HA and FBG groups. Both groups demonstrated significant neurological improvements postoperatively. No difference was observed in operating time, whereas the intraoperative blood loss was significantly less in the HA group. The fusion rates in the HA group were comparable to those in the FBG group. The incidences of general complications were similar in the 2 groups; however, prolonged donor-site pain was observed in 9 (36.0%) cases in the FBG group. Based on the results of this study, ACCF using HA is a safe and efficacious method for the treatment of patients with OPLL as an alternative to conventional ACCF using autologous fibula bone grafting. [Orthopedics. 2017; 40(2):e334-e339.].

Anterior cervical arthrodesis using a vertebral body autograft.

OBJECTIVE: To assess fusion rates and functional outcomes in patients undergoing anterior cervical discectomy and fusion by using a vertebral body autograft for interbody filling and anterior cervical plate fixation. MATERIAL AND METHODS: The study included a total of 102 patients, 54 men and 48 women, who underwent surgery between 2006 and 2010 patients with degenerative disease, cervical disc herniation and radiculopathy, and who had failed standard conservative treatment (3 months). The study was limited to patients with fusion levels 1-3. The mean patient follow-up was 44 (24-96) months. Their mean age was 48.8 years. RESULTS: The clinical variables analyzed were: duration of symptoms (> 12 months), smoking (31% smokers), employment status (76% active), average days of hospitalization (2.2 days), operation time (62 min), etiology (100%, degenerative disease), notable comorbidities (28%), fusion levels (42% 1, 49% 2, 9% 3), symptoms (radiculalgia or axial pain). The functional variables analyzed (score pre-and post-operative scores) were: VAS (8.6-1.32), Neck Disability Index (37.7-5.8), and Odom criteria (76% reflected excellent results after surgery). Finally, radiological variables were also analyzed: anterior reactive osteophytosis (16%), significant collapse (0%), and fusion rate (98%). There were 4 cases of acute postoperative complications, and 4 chronic, none of them were related to the surgical technique. DISCUSSION: The use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62 min duration of the procedure.

Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study.

BACKGROUND: Spinal fusion can be complicated by accelerated degeneration of the adjacent segments. Artificial disc replacements have been developed, but results are variable. Successful transplantations of intervertebral disc autografts, fresh allografts, and fresh-frozen allografts-ie, a non-fusion strategy-in which the mobility and stability of the spinal segment were preserved have been done in a primate model. Our aim was to determine the feasibility, safety, and long-term clinical results of disc transplantation in human beings. METHODS: Five patients, average age 47 years, with cervical disc herniation underwent transplantation of fresh-frozen composite disc allografts after disc excision. Serial MRI and static and dynamic radiographs were used to monitor the status of the grafts and the sagittal stability and mobility of the segment. FINDINGS: Good union of the graft endplates was seen by the end of 3 months after surgery in all patients. At a minimum follow-up of 5 years, the neurological symptoms of all patients had improved from before surgery levels. No immunoreaction was encountered. There was no olisthesis and only mild degenerative changes of the transplanted discs. All except one of the discs showed preservation of 7.0-11.3 degrees of sagittal motion at the final follow-up. MRI at 5 years showed preservation of hydration in at least two discs. INTERPRETATION: Despite signs of mild disc degeneration, the motion and stability of the spinal unit was preserved after transplantation of fresh-frozen allogenic intervertebral discs in our patients. With further refinements, such transplantations could be an effective treatment for degenerative disc disease.

Tratamiento de la discopatía cervical: evidencia válida 50 años después / Cervical disk treatment: valid evidence 50 years after

Se comenta una revisión sistemática sobre el estado actual de la cirugía anterior del disco cervical. Los autores de la revisión trataron de determinar que método de artrodesis intersomática cervical anterior, para uno o dos niveles, tuvo la mejor evolución clínico-radiológica en pacientes con enfermedad degenerativa discal. Sólo incluyeron estudios prospectivos, aleatorizados y controlados que comparaban deversas técnicas de discectomía, artrodesis e instrumentación. Surgió de la revisión, que las evidencias disponibles para tomar una decisión terapéutica valida, en el empleo de las diferentes técnicas, fueron débiles como consecuencia de la baja calidad metodológica de los estudios en el análisis. Palabras clave: artrodesis cervical anterior - discectomía cervical anterior - instrumentación - revisión sistemática

A systematic review about the current state anterior cervical disc surgery was commented. The authors of this review tried to determine which method of anterior cervical interbody fusion at one or two-levels provided the best clinical and radiological outcome in patients with degenerative disc disease. They only included prospective, randomized and controlled studies that compared several techniques of discectomy. fusion and isntrumentation. The review showed that at most trials analyzed were of low quality the evidences available to sustain a valid therapoeutic intervention were weak. Key words: anterior cervical discectomy, anterior cervical fusion, intrumentation, systematic review.

Tratamiento de la discopatía cervical: evidencia válida 50 años después / Cervical disk treatment: valid evidence 50 years after

Se comenta una revisión sistemática sobre el estado actual de la cirugía anterior del disco cervical. Los autores de la revisión trataron de determinar que método de artrodesis intersomática cervical anterior, para uno o dos niveles, tuvo la mejor evolución clínico-radiológica en pacientes con enfermedad degenerativa discal. Sólo incluyeron estudios prospectivos, aleatorizados y controlados que comparaban deversas técnicas de discectomía, artrodesis e instrumentación. Surgió de la revisión, que las evidencias disponibles para tomar una decisión terapéutica valida, en el empleo de las diferentes técnicas, fueron débiles como consecuencia de la baja calidad metodológica de los estudios en el análisis. Palabras clave: artrodesis cervical anterior - discectomía cervical anterior - instrumentación - revisión sistemática(AU)

A systematic review about the current state anterior cervical disc surgery was commented. The authors of this review tried to determine which method of anterior cervical interbody fusion at one or two-levels provided the best clinical and radiological outcome in patients with degenerative disc disease. They only included prospective, randomized and controlled studies that compared several techniques of discectomy. fusion and isntrumentation. The review showed that at most trials analyzed were of low quality the evidences available to sustain a valid therapoeutic intervention were weak. Key words: anterior cervical discectomy, anterior cervical fusion, intrumentation, systematic review.

Tratamiento de la discopatía cervical: evidencia válida 50 años después / Cervical disk treatment: valid evidence 50 years after

Se comenta una revisión sistemática sobre el estado actual de la cirugía anterior del disco cervical. Los autores de la revisión trataron de determinar que método de artrodesis intersomática cervical anterior, para uno o dos niveles, tuvo la mejor evolución clínico-radiológica en pacientes con enfermedad degenerativa discal. Sólo incluyeron estudios prospectivos, aleatorizados y controlados que comparaban deversas técnicas de discectomía, artrodesis e instrumentación. Surgió de la revisión, que las evidencias disponibles para tomar una decisión terapéutica valida, en el empleo de las diferentes técnicas, fueron débiles como consecuencia de la baja calidad metodológica de los estudios en el análisis. Palabras clave: artrodesis cervical anterior - discectomía cervical anterior - instrumentación - revisión sistemática(AU)

A systematic review about the current state anterior cervical disc surgery was commented. The authors of this review tried to determine which method of anterior cervical interbody fusion at one or two-levels provided the best clinical and radiological outcome in patients with degenerative disc disease. They only included prospective, randomized and controlled studies that compared several techniques of discectomy. fusion and isntrumentation. The review showed that at most trials analyzed were of low quality the evidences available to sustain a valid therapoeutic intervention were weak. Key words: anterior cervical discectomy, anterior cervical fusion, intrumentation, systematic review.

A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression.

A retrospective study of 201 patients who underwent multilevel anterior cervical decompression and fusion by multiple interbody grafting and long segment strut grafting without plate fixation was conducted from January 1991 to December 2001. Previous studies have reported lower fusion rates for anterior cervical decompressions reconstructed with multiple interbody grafts as opposed to a single long strut graft. Our aim was a retrospective study of two fusion techniques with reference to radiological and clinical outcomes in patients operated by the senior author. Of 132 patients who underwent strut grafting, 124 achieved solid fusion (93.9%), whereas 48 of 69 patients who underwent multiple interbody grafting (69.6%) achieved solid fusion. There were five cases of graft displacement or extrusion among strut-grafted patients and one among patients with interbody grafts. More 'good' and 'excellent' clinical outcomes were found among patients who underwent strut grafting (87.1 v. 81.1%). Patients with pseudoarthrosis had significantly poorer clinical outcomes. Therefore, corpectomy or vertebrectomy and strut grafting should be considered after multilevel anterior cervical decompression to increase the likelihood of successful fusion and to improve clinical outcome.

Transplantation of olfactory ensheathing cells fails to promote significant axonal regeneration from dorsal roots into the rat cervical cord.

The olfactory ensheathing cell (OEC) is a class of glial cell that has been reported to support regeneration in the central nervous system after various types of lesions, including rhizotomy of spinal dorsal roots at thoracic, lumbar and sacral levels. We have therefore carried out a detailed anatomical analysis to assess the efficacy of dorsal horn OEC transplants at promoting regeneration of primary afferents across the dorsal root entry zone (DREZ) at the cervical level in the adult rat. OECs were cultured from adult rat olfactory bulb and immunopurified (90% purity). Regeneration by large diameter afferents and by both peptidergic and non-peptidergic small diameter afferents was assessed using respectively cholera toxin B (CTB) labelling and immunocytochemistry for calcitonin gene-related peptide (CGRP) and the purinoceptor P2X3. Following an extensive (C3-T3) rhizotomy, CGRP and P2X3 immunoreactive axons regenerated across the rhizotomy site as far as the DREZ but there was no evidence of regeneration across the DREZ, except through sites where the OEC transplant was directly grafted into the DREZ. No evidence of regeneration into the dorsal horn by CTB-labelled axons was obtained. In addition, there was little sign of sprouting by intact axons in the vicinity of OEC transplant sites. In contrast to these results in vivo, cocultures of OECs and adult dorsal root ganglion cells showed that OECs stimulate extensive neurite outgrowth. The failure of the OECs to promote regeneration in vivo following cervical rhizotomy is therefore most likely due to factors in the environment of the graft site and/or the method of transplantation.

[Instability of atlanto-axial complex in a boy with isolated odontoid process]. / Niestabilnosc szczytowo-obrotowa u dziecka z odosobnionym zebem obrotnika (os odontoideum).

The authors present a case of a 14-years old boy, in whom, after a mild trauma, massive signs of cervical spinal cord injury appeared. Isolated odontoid process with instability of atlanto-axial complex proved to be the cause. In course of therapy with methylprednisolone and rehabilitation full recovery was achieved. The operative management consisted in posterior interlaminar stabilization C1-C2 with autologous bone transplant and titanium cable (Sof'wire). The etiology of this disturbance is discussed and operation method is presented.

Anterior cervical decompression and fusion for cervical spondylosis using vertebral grafts obtained from the fusion site. Technical advantages and follow-up results.

A retrospective analysis was done in 60 consecutive patients who underwent anterior cervical fusion using vertebral grafts obtained from the fusion site at the Nagoya University and its affiliated hospitals by a single surgeon (MT). Follow-up results and technical advantages are reported. The average follow-up period was 33 months (range 6 to 55 months). Sufficient decompression of the anterior cervical pathology was performed successfully via a wider operative field. The symptoms and neurological score improved significantly without any new deficits in all patients except in one with a three-level fusion who needed re-operation for further decompression. No major graft complications such as graft extrusion or pseudoarthrosis occurred. Graft fracture was noted in five cases. However, good bony fusion was observed in all these cases without any further treatment. Normal cervical lordosis was preserved in most cases except in four, who lost lordotic alignment but did not show kyphosis. Major advantages of this method are a wider operative field, excellent graft fusion rate, and no need for an additional incision to obtain autogenous bone graft. These benefits seem have to contributed to satisfactory surgical results in this series.

Anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies for ossification of the posterior longitudinal ligament of the cervical spine: technical note.

OBJECTIVE: To describe a surgical technique of anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies with ossification of the posterior longitudinal ligament of the cervical spine. This technique seeks to avoid complications associated with an anterior approach of decompression and bone fusion, which widely uses autogenous bone from the iliac crest. METHODS: Forty patients with cervical myelopathy were studied. The ossified ligament was localized to one, two, three, four, five, six, and seven vertebral bodies in 10, 18, 5, 4, 1, 1, and 1 patients, respectively. The ossified area of all posterior longitudinal ligament was completely removed using microsurgical techniques, and 11 patients were operated on at one level, 21 at two levels, and 8 at three levels. RESULTS: The symptoms of all patients improved after the operation. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 3 years (range, 1-5.25 yr). Anterior angulation was found in one of eight patients (13%) who underwent three-level fusion. CONCLUSION: Two major advantages were as follows: 1) no complications related to the iliac donor site occurred, and 2) early mobilization of patients was possible with a soft cervical collar. Anterior decompression and fusion should be used for cases with ossification of up to three consecutive vertebrae needing either one- or two-level fusions.

Comparison of anterior cervical fusions using autogenous bone graft obtained from the cervical vertebrae to the modified Smith-Robinson technique.

Anterior cervical discectomy and interbody grafting provide excellent results in treating cervical radiculopathy. This prospective study compares the results of the technique obtaining autogenous bone from the cervical vertebrae for grafting to the modified Smith-Robinson technique using autogenous iliac crest graft. Seven levels in six patients were fused using the vertebral body autograft technique and 43 levels in 40 patients using the standard technique. All patients had radiculopathy and neck pain. Statistically significant differences in fusion rate (4/7 vertebral body autograft; 40/43 modified Smith-Robinson) (p = 0.029), disc height maintenance (p = 0.001), and neck pain improvement (p = 0.05) occurred between the techniques. We do not recommend vertebral body autograft over the modified Smith-Robinson technique for anterior cervical fusion following discectomy.

The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies.

The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

[Use of a vertebral body graft in cervical spine injuries]. / Utilisation du greffon corporéal vertébral en pathologie rachidienne cervicale traumatique.

The authors describe the use of body vertebral graft in post-traumatic cervical spine injuries. They underline its advantages.

Indications for halo immobilization of the cervical spine.

In the United States, cervical spine injuries are routinely immobilized with the halo apparatus. In Europe, this device is seldom used except in the treatment of spinal deviations. Based on studies of five cases the authors discuss the indications for use of the halo device in cervical spine injuries.

Reactions of transplanted neurocentral synchondroses to different conditions of mechanical stress. A methodological study on the rat.

In order to elucidate the reactions of neurocentral synchondroses to different forces, the first cervical vertebra of 10 or 25 days old rats was transplanted into sex-matched litter mates. Some vertebrae were transplanted as a whole, in some only the ventral part with its synchondroses was transplanted and, in others the lumen was furnished with an expanding sponge or a spring. The transplantation was done subcutaneously and, in the case of the fragments, intracerebrally as well. The synchondroses of the vertebrae transplanted at 10 days did not differ very much from those of the host 5, 10 or 15 days after the operation, whereas in the vertebrae transplanted at 25 days the synchondroses underwent synostosis earlier than in situ. The synchondroses of the transplanted fragments, and especially of those placed intracerebrally, remained open longer than those in the whole vertebral transplants; the sponge and and the spring also delayed closure. In the synchondroses transplanted at 25 days there was a strong reduction in alcian blue staining, whereas in the spring loaded synchondroses the stainability persisted longer, maybe as an adaptation to the tensile force. It seems that the inherent potential of the neurocentral synchondroses to obliterate at a certain time can be altered by changing the biomechanical conditions.